Chronic Pelvic Pain In Men

What is chronic pelvic pain?

Chronic pelvic pain, also called CPP, is a discomfort in the pelvic area that lasts a long time. The pelvic area is the area between your hips from the umbilicus (belly button) to the groin. It contains the organs of the digestive, urinary, and reproduction systems. These organs include the intestines (bowel), bladder, and prostate.

Chronic pelvic pain is pain that is steady, worsens, or keeps coming back for at least six months. It may also be pain that does not go away for at least three months. The pain is bad enough to cause problems with your daily activities. It may affect your physical, mental, or social well being. CPP is a symptom of a disease, infection, injury, or other condition.

What causes chronic pelvic pain?

Any problem in the organs, skin, muscles, bones, ligaments, and nerves in your pelvic area can cause CPP. CPP may occur with an infection or inflammation (swelling) of one or more parts in your pelvic area. CPP is often caused by more than one problem. Any of the following may cause CPP or make it worse:

• Anal conditions: Pain may come from a problem in your anus or rectum (lower part of your bowel). These may be any of the following:
  
  
  • Anal fissure: This is a cut or small tear on the inside of your anus. Ask your caregiver for more information about anal fissure.
    
    
  • Hemorrhoids: These are swollen veins on your anus or inside your rectum. Ask your caregiver for more information about hemorrhoids.
  
  
• Mental or emotional problems: Depression (deep sadness), stress, or problems sleeping may make you more likely to have CPP. CPP is also more likely to occur if you have been physically or sexually abused. You may also have CPP if you abuse alcohol or drugs.
  
  
• Muscle and nerve conditions:
  
  
  • Nerve problems: Nerves in the pelvic area can be pinched by tight muscles, or by scars or fascia tissues. Spinal nerves for the pelvis can be pinched by too small openings in the vertebrae (bones of the spine).
    
    
  • Pelvic floor muscle problems: The pelvic floor muscles help support the hips and hold the pelvic organs in place. Pain may occur when these muscles become short, tight, or tense. Tense pelvic muscles may be caused by often holding off the need to urinate (pass urine).
    
    
  • Side effect of past surgery: Surgery in your pelvic area, such as hernia repair or vasectomy, may cause other problems and pain. A hernia is a part of an organ or tissue that squeezed into another portion of the body. Vasectomy is surgery to cut your tubes that carry your sperm to the urethra (outside opening of the penis).
  
  
• Reproductive system conditions:
  
  
  • Prostatitis: This condition may be an infection or inflammation (swelling) of the prostate gland. The infection may be caused by germs, such as bacteria or viruses. Ask your caregiver for more information about prostatitis.
    
    
  • Other changes: Any condition that results in pressure being put on nearby structures can cause pain. Abnormal growths, such as tumors of the testicles and cysts within the epididymis, may cause pain. Varicoceles (enlarged veins in the scrotum) and hydroceles (fluid inside the scrotum) may lead to increased pressure on other organs. Ask your caregiver for more information about hydrocele or varicocele.
  
  
• Urinary conditions: The most frequent urinary system cause is:
  
  
  • Interstitial cystitis: This is a problem where there is inflammation of the bladder. The bladder is swollen, causing pain as it fills with urine.
    
    
  
  
• Unknown cause: Sometimes, the exact cause of CPP may not be known. You have symptoms of a lower urinary tract, sexual, or bowel condition, but no infection or problem is found. This may be called chronic pelvic pain syndrome (CPPS) .

How can I tell my caregiver about my pelvic pain?

Tell your caregiver when you last had pelvic pain, and how it started. Show him where you feel pain and how your pain feels, Tell him how bad it is, how long it lasts, and how often it happens. Tell your caregiver what you were doing before it happened. Tell him what things make your pain feel better and worse. Tell your caregiver about other signs and symptoms that you have. Tell him if you have other diseases, infections, surgeries, or procedures in the past.

What signs and symptoms may come with chronic pelvic pain?

You may feel pain on one or both sides of your pelvis, or all over the pelvic area. The pain may increase or decrease with certain body positions or activities. Sitting or standing for a long time, moving your bowels, having sex, or urinating may worsen your pain. Other common signs and symptoms include:

• Problems urinating:
  
  
  • Burning feeling when you urinate.
    
    
  • Feeling that your bladder has not completely emptied after passing urine.
    
    
  • Needing to urinate right away.
    
    
  • Passing urine more often than usual or you need to wake up at night often to urinate.
    
    
  • Trouble starting to urinate, or passing little amounts of urine or none at all.
  
  
• Sexual problems:
  
  
  • Premature or painful ejaculation. Ejaculation is the forceful release of semen from the penis.
    
    
  • Unable to have or maintain erection. An erection is when the penis gets stiff so that sexual intercourse (sex) is possible.
    
    
  • Not being able to get your female sexual partner pregnant when you are trying to have a baby.
  
  
• Other signs and symptoms:
  
  
  • Backache, headache, neck pains, or pain in the legs.
    
    
  • Feeling tired most of the time or getting tired very easily.
    
    
  • Urine or semen that is pink or red.

How may my chronic pelvic pain be treated?

You may need one or more of the following:

• Medicines:
  
  
  • Analgesics: This is a group of medicines that includes most pain relievers. Analgesics may help decrease pain and swelling. Some analgesics may also be used to decrease fever.
    
    
    • Bladder analgesic medicine: You may have a liquid medicine put directly into your bladder. It may help relieve the pain and swelling in your bladder.
      
      
    • Nonsteroidal anti-inflammatory (NSAID) medicine may decrease swelling and pain or fever. This medicine can be bought with or without a doctor's order. This medicine can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your primary healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow the directions on it before using this medicine.
      
      
    • Opioids: These medicines, which include codeine and morphine, are used for moderate to severe (very bad) pain.
    
    
  • Other medicines that help treat pain and discomfort:
    
    
    • Alpha blockers: These medicines work by stopping a hormone that tightens blood vessels. This medicine relaxes the muscles in your prostate and bladder. It may help you urinate more easily.
      
      
    • Antibiotics: Pain caused by infections may be treated with antibiotic medicine to kill the germs.
      
      
    • Anticonvulsants: These are usually given to control seizures (convulsions) but may also be used to decrease pain. They may also help you sleep better at night.
      
      
    • Antidepressants: These are usually given to help decrease or prevent the symptoms of depression. They act by increasing certain chemicals in your body which may also help relieve pain. Chronic pain treatment often includes these medicines, even if you are not depressed.
      
      
    • Antihistamines: Some antihistamine medicines may be used to treat interstitial cystitis. These are medicines that are more commonly used for allergies or stomach acid problems.
      
      
    • Cystitis agent: Interstitial cystitis may be treated with a medicine that relieves bladder pain.
      
      
    • Muscle relaxants: Pain from muscle spasm may be eased with medicine that helps your muscles relax. In addition to oral medicines for spasms, botox injections may be used to treat spasticity. Spasticity is increased muscle tone that can cause frequent or ongoing spasms.
  
  
• Physical therapy: Physical therapy (PT) includes different ways to help decrease your pain. It may include applying heat, pressure and massage to painful areas, and special exercises. These exercises can help stretch and strengthen your pelvic floor muscles, or make you feel relaxed.
  
  
• Other therapies for pain:
  
  
  • Acupuncture: Acupuncture is a treatment based on a belief that fluids flow through channels in our bodies. Caregivers insert very thin needles just under your skin. This is believed to open the channels, allowing fluids to flow better. This treatment may decrease pain and improve healing. Always see a caregiver for acupuncture. Do not try to give this treatment to yourself.
    
    
  • Biofeedback training: Biofeedback is a special way to control how your body reacts to things like stress or pain. The first step in this training is to use electrodes (wires) to monitor your body responses. These electrodes are placed on different parts of your body, such as your chest. The electrodes are attached to a TV-type monitor which gives a paper tracing of your heart beating. You will learn how to control body changes, such as slowing your heart rate, when you become upset.
    
    
  • Nerve stimulators: A transcutaneous electrical nerve stimulator (TENS) unit is a small battery-powered device used for chronic pain. It attaches with wires to patches placed on the skin over the painful area. The patches deliver very mild electrical current to the skin. This acts to block pain from the nerves below and increases your body's own pain relievers. This may help decrease or control your pain when used over a painful body part. Some men with chronic pain may be treated with a surgically placed device. It blocks pain by sending electrical impulses to the sacral nerves in the lower spine.
  
  
• Surgery: If other treatments do not relieve your pain, your caregiver may do surgery to help relieve it. Your caregiver may remove adhesions or tissues, or organs that are causing your pain.
  
  
• Counseling: CPP may affect many areas of your life. It can affect your appetite for food, how well you sleep, and your energy and ability to do things. It can also affect your mood (how you feel about things) and your relationships with others. Meetings may be held for you, your family, and people close to you. These meetings can help everyone better understand your health condition and how to manage it.

What can I do to prevent or help treat my chronic pelvic pain?

• Change your diet if you have interstitial cystitis. If caregivers have told you that you have interstitial cystitis, avoid foods that may irritate your bladder. These include aged cheeses, sour cream, yogurt, chili peppers, lima beans, tomato, citrus fruits, mayonnaise, and peanuts. Avoid drinks, such as beer, citrus juices, sodas, wines, tea, and regular coffee. Ask your caregiver if you need to follow a special diet.
  
  
• Keep a pain diary. It may be easier to answer your caregiver's questions by making a pain diary or book. A pain diary will help you remember exactly what happened each day because it is all written down. This will help you tell caregivers about your pain and may help them figure out what is causing it. Write down all the words that come to you to describe your pain. A diary also helps track pain cycles. This may make you more aware of when and how the pain may start and end.
  
  
• Learn ways to relax. Deep breathing, meditation, and relaxation exercises are some ways to help you relax. Talk to someone about things that upset you.
  
  
• Make some changes in your activities if you have prostatitis. Avoid riding bikes. Do not hold off passing your urine. Urinate when you feel the need for it.
  
  
• Talk to your caregiver about over-the-counter medicines. Over-the-counter (OTC) medicines can be bought without a prescription (order) from a caregiver. These medicines are safe for most people to use and can help you feel better when used correctly. However, they can cause serious problems when they are not used correctly. People using certain other medicines or that have certain medical conditions are at a higher risk for problems. Using too much or using these medicines for longer than the label says can also cause problems. Follow directions on the label carefully. If you have questions, talk to your caregiver.

Will I need appointments with other caregivers?

You may need to see a specialist depending on the condition that seems to be causing your CPP. If you have problems passing urine or with sexual activities, you may need to see a urologist. You may need to see a specially trained surgeon if you an anorectal condition. If your pain does not get better even with treatment, you may need an appointment with a pain management specialist.

What should I expect with time or treatment?

Relief from CPP depends on the disease or problem that is causing it. All conditions causing the pain will need to be treated. Treatment of one or some of them may only give short term relief. Some CPP cannot be completely cured. The aim of chronic pain management is to decrease pain to allow you to do your usual activities. These include going back to work, attending school, and exercising.

When should I call my caregiver?

Call your caregiver if:

• You develop new symptoms or your symptoms are worse than before.
  
  
• You feel very anxious or irritable after you take your medicines.
  
  
• You have blood in your urine or stool (bowel movements).
  
  
• You have problems sleeping or thinking clearly, or feel so depressed that you cannot cope.
  
  
• You have trouble urinating or emptying your bladder completely.
  
  
• You have questions or concerns about your pain, condition, treatment, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You have severe (very bad) pelvic pain that does not go away after taking medicine.
  
  
• You have severe chest pain and trouble breathing all of a sudden.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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